CCGs have been warned that blanket bans on prescribing of over-the-counter medicines are likely to be challenged and to be ‘mindful’ of the exceptions in the NHS England guidance.
In a newsletter to CCGs, NHS Clinical Commissioners highlighted the exemptions from new OTC prescribing rules and said they should be taken into account when developing local plans.
NHS England issued guidelines in March calling on CCGs to curb prescriptions for OTC medicines for conditions such as constipation, diarrhoea and athlete’s foot.
After a lengthy consultation, the final recommendations, which cover routine prescribing for 35 minor conditions, included exemptions patients where the clinician believes they will struggle to self-manage because of medical, mental health problems or ‘significant social vulnerability’.
The guidance also does not apply to patients with long-term or more complex conditions who will continue to get their usual prescriptions.
But GPs have reported receiving an increasing number of complaints as they try to follow the guidance.
Pulse has reported that several CCGs, including NHS Luton CCG, have put in place a ban on GPs prescribing any OTC medicines apart from in exceptional circumstances.
Many had moved to ban OTC prescriptions before the NHS England guidance was published, including NHS East Lancashire CCG, NHS Dudley CCG, NHS Barking and Dagenham CCG, NHS Bedfordshire CCG and NHS Croydon CCG.
The advice from NHS Clinical Commissioners also points to exceptions in prescribing of liothyronine which includes patients treated with levothyroxine who continue to suffer with symptoms.
A spokesperson said: ‘As part of our work with NHS England on the commissioning guidance regarding items which should not be routinely prescribed in primary care, in July we sent our members a reminder of the exceptionalities that are in the guidance, including those that specifically relate to liothyronine.
‘Whilst it is entirely for each CCG to make their own decision about the local approach that is taken, there is the potential for CCGs to receive local challenges to any blanket ban decisions.
‘We emphasised to members that they should be mindful of those exceptionalities when developing their local commissioning policies.’
Dr Richard Vautrey, chair of the BMA’s GP Committee, said GPs were being caught between a rock and a hard place with the implementation of this guidance and needed flexibility.
‘They know that they are contractually required to issue a prescription and yet their CCG is strongly encouraging them not to do so, and all too often it is the GP who takes the flack from unhappy patients.
‘GPs want to do the best for their patients and will take both cost and clinical effectiveness in to account when making prescribing decisions.
‘It is important that CCGs provide clearer advice directly to patients about decisions they have made but also give prescribers appropriate flexibility to respond to the needs of their patients and not place them in impossible positions.’